新辅助化疗后行腹腔镜手术与开腹手术治疗进展期胃癌的Meta分析

Meta-analysis of laparoscopic surgery versus open surgery for advanced gastric cancer after neoadjuvant chemotherapy

目的:应用Meta分析评估新辅助化疗后行腹腔镜与开腹手术治疗进展期胃癌的短期结果与远期预后。方法:利用计算机检索Cochrane Library、Embase、PubMed、中国知网、万方等数据库,检索时间截至2021年8月1日。根据纳入与排除标准对文献进行筛选,并提取相关数据。使用RevMan 5.3进行Meta分析。结果:本研究共纳入10篇文献、961例患者,腹腔镜组379例,开腹组582例。Meta分析结果显示,腹腔镜组术中出血量少(MD=-64.78,95%CI:-100.19~-29.37,P=0.0003),术后排气早(MD=-0.34,95%CI:-0.59~-0.08,P=0.009),术后住院时间短(MD=-2.59,95%CI:-5.07~-0.10,P=0.04),但手术时间长(MD=30.37,95%CI:25.25~35.48,P<0.00001)。两组术中清扫淋巴结数量(MD=-0.50,95%CI:-2.65~1.66,P=0.65)、术后30 d手术并发症发生率(OR=0.78,95%CI:0.53~1.13,P=0.19)、首次排便时间(MD=0.00,95%CI:-0.10~0.10,P=0.98)、术后首次进食时间(MD=-0.05,95%CI:-0.22~0.12,P=0.54)差异无统计学意义。对于远期预后,两组术后3年总体生存率(OR=1.06,95%CI:0.40~2.83,P=0.90)、5年总体生存率(OR=1.26,95%CI:0.46~3.43,P=0.66)差异无统计学意义。结论:腹腔镜技术应用于新辅助化疗后的进展期胃癌具有良好的临床疗效与安全性,且对患者远期预后无不良影响。

Objective:To conduct a meta-analysis evaluating the short-term results and long-term prognosis of laparoscopic surgery and open surgery for advanced gastric cancer after neoadjuvant chemotherapy.Methods:The literatures in PubMed,Cochrane Library,Embase,CNKI and Wanfang databases were searched by computer,and the search ended on Aug.1,2021.According to inclusion and exclusion criteria,the literatures were screened and the relevant data were extracted.Meta-analysis was performed using RevMan 5.3.Results:Ten studies with a total of 961 patients(379 patients in the laparoscopic group and 582 patients in the open group)were included in this study.The laparoscopic group had less intraoperative blood loss(MD=-64.78,95%CI:-100.19~-29.37,P=0.0003),earlier postoperative exhaust(MD=-0.34,95%CI:-0.59~-0.08,P=0.009),and shorter postoperative hospital stay(MD=-2.59,95%CI:-5.07~-0.10,P=0.04),but the operative time was longer(MD=30.37,95%CI:25.25~35.48,P<0.00001).There was no significant difference between the two groups in the number of lymph nodes dissected during operation(MD=-0.50,95%CI:-2.65~1.66,P=0.65),the incidence of surgical complications 30 d after operation(OR=0.78,95%CI:0.53~1.13,P=0.19),the time of first defecation(MD=0.00,95%CI:-0.10~0.10,P=0.98)and the time of first postoperative feeding(MD=-0.05,95%CI:-0.22~0.12,P=0.54).As for long-term postoperative prognosis,there was no significant difference between the two groups in 3-year overall survival rate(OR=1.06,95%CI:0.40~2.83,P=0.90)and 5-year overall survival rate(OR=1.26,95%CI:0.46~3.43,P=0.66).Conclusions:The application of laparoscopic technique in advanced gastric cancer after neoadjuvant chemotherapy has good clinical efficacy and safety,and has no adverse effect on the long-term prognosis of patients.